Idiopathic Intracranial Hypertension

(Benign intracranial hypertension, pseudotumor cerebri)

Idiopathic intracranial hypertension causes increased intracranial pressure, without a space-occupying lesion or hydrocephalus, presumably by the venous drainage is blocked; the composition of cerebrospinal fluid is normal.

Idiopathic intracranial hypertension causes increased intracranial pressure, without a space-occupying lesion or hydrocephalus, presumably by the venous drainage is blocked; the composition of cerebrospinal fluid is normal.

(. See also examination of headache patients) idiopathic intracranial hypertension causes increased intracranial pressure, without a space-occupying lesion or hydrocephalus, presumably by the venous drainage is blocked; the composition of cerebrospinal fluid is normal. Idiopathic intracranial hypertension (pseudotumor cerebri) typically occurs in women of childbearing age. The incidence is 1 / 100,000 in women of normal weight, but 20 / 100,000 in overweight women. The intracranial pressure is elevated (> 250 mm H2O); the cause is unknown, but an obstruction of cerebral venous outflow may play a role, possibly because the venous sinuses are narrower than gwöhnlich. In children, this disorder develops sometimes after the use of corticosteroids has been completed, or after children have taken large amounts of tetracycline. Symptoms and complaints Almost all patients have generalized headache with fluctuating intensity, at times with nausea daily or almost daily. They may also temporary obscuration of vision, diplopia have (due to malfunctions of the VI. Cranial nerves) and a pulsatile intracranial tinnitus. The vision loss begins peripherally and can not be noticed often up to a late stage by the patient. A permanent visual loss is the most serious consequence. Once vision is lost, it will not return to the rule, even if ICP is reduced. A bilateral papilledema often; few patients have no or only a unilateral papilledema. In some asymptomatic patients, the optic disc is discovered during a routine ophthalmoscopic examination. On neurological examination sometimes paralysis of the VI can. be determined cranial nerves, but is otherwise unremarkable. Tips and risks if clinical findings suggest idiopathic intracranial hypertension, check visual fields and “optic fundi” even if patients have no visual symptoms. Diagnostic MRI with magnetic resonance venography lumbar puncture If clinical findings nahelgen idiopathic intracranial hypertension, doctors should check visual fields and “optic fundi”, even in patients without visual symptoms. The diagnosis is suspected clinically and then secured by a brain imaging (preferably using MRI venography), the normal results equivalent (except for “venous transverse”) and a subsequent -if not kontraindiziert- lumbar puncture with CSF, the increased opening pressure and a normal Liquorzusammensetzung displays. The use of certain medications and certain diseases throw a clinical image that is similar to idiopathic intracranial hypertension and should be excluded (see table: states associated with papilledema and idiopathic intracranial hypertension are similar). States that are associated with papilledema and idiopathic intracranial hypertension are similar to state examples obstruction of cerebral venous outflow Cerebral sinus venosus thrombosis jugular vein thrombosis disease Addison COPD Hypoparathyroidism Severe iron deficiency anemia obesity (usually in young women) Polycystic Ovarian Syndrome kidney failure right ventricular heart failure with pulmonary hypertension sleep apnea Arzneimi ttel Anabolic steroids discontinuation of corticosteroids after prolonged use growth hormone in patients with a corresponding lack nalidixic acid nitrofurantoin, tetracycline and its derivatives vitamin A toxicity treatment acetazolamide weight loss migraine medications, v. a. Topiramate Idiopathic intracranial hypertension occasionally goes back even without therapy. The treatment of idiopathic intracranial hypertension is directed to the following: the reduction of pressure the preservation of vision symptom relief, the carbonic anhydrase inhibitor acetazolamide (250 mg po 4 times a day) is used as a diuretic. Obese patients are encouraged to decrease, which can contribute to the reduction of the intracranial pressure. Serial lumbar punctures are controversial, but they are sometimes performed, v. a. when vision is threatened while waiting for the final treatment. All potential causes (illnesses or medication) can be corrected or eliminated wherever possible. Migraine medications (especially topiramate inhibits carbonic anhydrase) can relieve headaches. NSAIDs may be used if necessary. If the visibility worsened despite treatment, one of the following may be prescribed: “Optic nerve sheath fenestration” maneuver (lumboperitoneal or ventriculoperitoneal) Endovascular Venous Stenting bariatric surgery with permanent weight loss can cure the disease in obese patients who were otherwise unable , to decrease. Frequent ophthalmologic examinations (incl. A quantitative field test) are necessary to monitor the response to treatment. Control of the vision is not sensitive enough to detect an imminent loss of vision. Important points Pull idiopathic intracranial hypertension considered if patients, particularly obese women, daily generalized headache with or without visual symptoms; Check visual fields and “optic fundi”. Diagnosis based on results of brain imaging (preferably MRI with venography) and, if not contraindicated, lumbar puncture. Guess to reduce weight if necessary and treat you with acetazolamide. Frequent ophthalmologic examinations (incl. A quantitative field test) to monitor the response to treatment.

Health Life Media Team

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